I was diagnosed with HIV in January 2011, with a normal CD4 count but high viral load (>500,000). As I still had a high viral load six months later (330,000), I decided to go on treatment with Atripla on 1 August. The post-tablet buzz and early morning grogginess disappeared after a few days, but it was the rash that appeared on day 8 that was the killer. This short blog will document how I either medicate through it and suffer this rash to its conclusion, or switch to another medication.

Monday, 15 August 2011

day 13

I woke, furiously scratching at my hands and feet again, and prepared for another day indoors with books. My face was red and warm, although not itchy, it was less oily than before, and showed no spots - it looked as though I'd got sunburnt on the snowfields, as the area around my eyes was unaffected. My ears were still hot and red. For the rest of the day, the rash set about filling in any gaps it had left in the previous days. This meant it started marching actively down my forearms, calves and shins, and working outwards from older, paler spots that had seeded themselves there in previous days. I cancelled all social engagements for that day, and prepared for (hopefully) my last difficult day.

In truth, the days were always much easier to handle than the nights. Dozing on the couch or sleeping brought out the beast in the rash, so as long as I stayed awake, kept my apartment unheated, didn't wear shoes or a watch, and kept fairly cool and calm, I didn't have such a bad day. I was playing a waiting game. I knew that so far, wherever the rash had been, it didn't reappear, and it had been almost everywhere now, fading steadily in the oldest parts. I knew it wouldn't quit until it filled all the gaps, but as my hands were now almost uniform with rash and looking a lot less angry, and as the gaps on my feet were steadily being filled, it was just a matter of time before the rash burnt itself out.

In the morning, my forearms and hands, calves, and feet looked like this:

I went back to regularly plunging them up to knee and elbow in the ice-cold water of my bath, leaving them there for at least five minutes, and patting them carefully dry.

This is what my right forearm and shins looked like later in the day:

I had another night similar to the previous night, but not quite as intense. The worst of it, as always, was the swelling of my hands and feet within 30 minutes of being in bed, followed by the feeling of being pricked by pins, then itchiness, then heat, then impossible-to-resist itchiness. I ended up frenetically scratching and rescratching all areas that had active rash on them (hands, feet, between fingers and toes, ankles, skins, tendons), noticing that once I started one scratch, it seemed to signal either via nerves or chemicals for another area to itch to the point it then had to be scratched, and so on. This time, what was worrying, was that the itch extended up into my right thigh and started on my buttocks. Was a new front being opened up in the rash's war with my skin - a first salient in a dreaded Reconquista?

This time, I sat down fully in the ice-cold bath up to my stomach and sat there until it felt safe to return to the bed. At 2 am, this was the state of play: